经胫前隧道推顶复位胫骨平台塌陷骨折  

Pushing reduction via a pretibial bone tunnel for treatment of tibial plateau fracture

作　　者：郑占乐[1] 连晓东[1] 王博[1] 吕红芝[1] 朱燕宾 张英泽[1] Zheng Zhanle;Lian Xiaodong;Wang Bo;Lyu Hongzhi;Zhu Yanbin;Zhang Yingze(Trauma Emergency Center,Third Hospital of Hebei Medical University,Key Laboratory of Orthopaedic of Hebei,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院创伤急救中心,河北省骨科重点实验室,石家庄050051

出　　处：《中华创伤骨科杂志》2020年第8期693-697,共5页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然基金青年基金(81702139);河北省自然基金青年基金(H2018206223)。

摘　　要：目的探讨应用经胫前开孔隧道推顶复位微创治疗胫骨平台骨折的短期疗效。方法回顾性分析2019年3月至6月于河北医科大学第三医院创伤急救中心应用经胫前开孔骨隧道顶起复位微创治疗的9例胫骨平台患者资料。男6例,女3例;年龄26~63岁,平均38岁;左侧5例,右侧4例。按照Schatzker分型:Ⅱ型7例,Ⅲ型2例;按照胫骨平台骨折综合分型均为Ⅰ型。所有患者在全身麻醉或椎管内麻醉下进行手术,根据骨折线波及的长度,在胫骨结节内下方远端骨折线以远1~2 cm胫骨前内侧面使用环钻建立骨隧道,经骨隧道顶棒复位塌陷骨折,之后选择自身双皮质自体髂骨或人工骨棒进行植骨支撑。使用膝关节外侧小切口置入接骨板,术中使用关节镜测量骨折移位程度,记录每位患者的手术时间、胫前切口长度、透视次数、术中出血量和术后并发症发生率。结果9例患者手术时间为40~60 min,平均48.3 min;术中出血量为35~60 mL,平均46.1 mL;透视次数为12~21次,平均为17.4次;复位切口长度为1.6~3.0 cm,平均2.3 cm;固定完成后关节镜检查骨折移位程度为0~2.0 mm,平均0.8 mm;术后15 d膝关节最大活动度125°~140°,平均128.9°。所有患者切口均一期愈合,有1例患者术后出现小腿腓静脉血栓,无术后感染及相关并发症发生。结论经胫前开孔骨隧道微创推顶复位法治疗胫骨平台骨折的短期效果肯定,但还需要进一步扩大病例,从而获得更加可靠的研究结论。Objective To analyze the short-term efficacy of pushing reduction via a pretibial bone tunnel for treatment of tibial plateau fracture.Methods From March 2019 to June 2019,9 patients were treated at Trauma Emergency Center,Third Hospital of Hebei Medical University for tibial plateau fractures by pushing reduction through a pretibial bone tunnel.They were 7 males and 2 females,aged from 26 to 63 years(average,38 years).Involved were 5 left sides and 4 right sides.According to the Schatzker classification,there were 7 cases of typeⅡand 2 ones of typeⅢ.According to the Zhang's comprehensive classification of tibial fractures,they were all typeⅠ.The patients were operated on under general anesthesia or intraspinal anesthesia.According to the length of fracture line,a circular drill was used to establish a bone tunnel which was 1 to 2 cm away from the distal fracture line.The collapsed fracture was reduced by the bar through the bone tunnel.A bicortical autogenous iliac bone or artificial bone bar was selected for bone grafting.The plate was placed through small incisions.Arthroscopic examination was used to measure the fracture displacement.The operation time,incision length,number of fluoroscopy,intraoperative blood loss and postoperative complications were recorded.Results For the 9 patients,operation time ranged from 40 to 60 minutes(average,48.3 minutes),intraoperative blood loss from 35 to 60 mL(average,46.1 mL),number of fluoroscopy from 12 to 21 times(average,17.4 times),length of reduction incision from 1.6 to 3.0 cm(average,2.3 cm),fracture displacement after fixation from 0 to 2.0 mm(average,0.8 mm),and maximum mobility of the knee joint from 125°to 140°(average,128.9°)15 days after operation.All incisions healed well by the first intention.Fibular vein thrombosis occurred in one case after operation.There were no infections or related complications.Conclusion The short-term efficacy of pushing reduction through a pretibial bone tunnel for treatment of tibial plateau fracture is positive,but more

关 键 词：膝关节 外科手术 微创性 骨板 胫骨平台骨折 骨隧道 

分 类 号：R687.3[医药卫生—骨科学]